Version June 2024
| Cause of PEEVO | Fluid type | Patient characteristics | Pleural fluid characteristics | Diagnostic test |
| Transudative PEEVO | ||||
| PDAPE | Peritoneal dialysate | Unilateral effusion in patient undergoing peritoneal dialysis (fluid migrates across the diaphragm) | Clear fluid, transudate with very low protein | Glucose = 200 to 2000 mg/dL, PF/S glucose >1 |
| Urinothorax | Urine | Ipsilateral effusion in a patient with obstructive uropathy or iatrogenic/traumatic injury to GU tract Urinoma may be present on imaging | Serous, transudate with very low protein (<1 mg/dL), pH <7.40 | PF/S creatinine >1 (supportive) >1.7 (diagnostic) |
| EVM of CVC | Intravenous fluid | Ipsilateral effusion in a patient with newly placed CVC (catheter migrates through the posterior venous wall and mediastinal pleura) | Serosanguinous (if mixed with blood) transudate with very low protein, IV fluid content* | Content reflective of infusate (eg, high glucose if dextrose) |
| VP or VPL shunt DPF | CSF | Effusion in patient with VP or VPL shunt Patient with an effusion who has a spinal cord tumor or is status post a neurosurgical procedure (eg, laminectomy, discectomy) or thoracic surgery (eg, thoracotomy or thoracoscopy) | "Clear water," transudate with very low protein (<1 mg/dL) | Beta2 transferrin present |
| Glycinothorax | Irrigation fluid rich in glycine | Effusion in a patient undergoing irrigation for transurethral bladder surgery | Clear fluid, transudate | PF/S glycine 300:1 or higher |
| Hepatic hydrothorax | Ascites | Effusion in a patient with portal hypertension | Clear transudate similar to ascites (unless infected) | Clinical diagnosis of exclusion |
| Exudative PEEVO | ||||
| Esophageal or gastric perforation | Infected or esophageal/gastric contents | Unilateral, often left-sided effusion in a patient with injury or pathology of the esophagus or stomach | Purulent, foul odor, exudate with high PMN, LDH >1000 IU/L, Ph5-7 | PF/S amylase >1 Salivary isoenzyme Food particles |
| Enteral feeding tube migration | Enteral formula | Patient with effusion (often left-sided) after misplacement of feeding tube (penetration of esophagus or tracheobronchial tree) | Milky fluid, exudate | TG >110 mg/dL [1.24 mmol/L], PF/S glucose >1 |
| Pancreaticopleural fistula | Pancreatic fluid | Right-sided effusion in patient with chronic pancreatitis or pseudocyst | Turbid yellow, exudate | Amylase >100,000 IU/L (pancreatic isoenzyme) |
| Bilothorax | Bile | Right-sided effusion following injury to the biliary tree, or from biliary tract obstruction or from parasitic infection of liver, or sub diaphragmatic abscess | Green and turbid, exudate with signs of infection (eg, high white blood cell count, high percentage of neutrophil, high lactate dehydrogenase, pH <7.2, low glucose) | PF/S bilirubin >1 (organisms may be present) |
| Chylothorax | Chyle (lymphatic fluid) | Effusion in patients with lymphatic pathology (eg, tumors, trauma, LAM) | Milky fluid, exudate | TG >110 mg/dL [1.24 mmol/L] and/or detection of chylomicrons |
| Cholesterol effusion | Cholesterol | Effusion in a patient with tuberculosis or rheumatoid arthritis | Milky fluid exudate | Pleural fluid cholesterol level ≥200 mg/dL [≥5.18 mmol/L], a cholesterol to triglyceride ratio >1 in the pleural fluid, chylomicrons absent |
PEEVO: pleural effusion of extra-vascular origin; PDAPE: peritoneal dialysis-associated pleural effusion; PF/S: pleural fluid to serum ratio; EVM: extravascular migration; CVC: central venous catheter; VP: ventriculoperitoneal; VPL: ventriculopleural; CSF: cerebrospinal fluid; DPF: duropleural fistula; PMN: polymorphonuclear neutrophil; LDH: lactate dehydrogenase; TG: triglyceride; LAM: lymphangioleiomyomatosis.
* Exception is when total parenteral nutrition or lipids are being infused, in which case protein is present and fluid will be milky, respectively.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
